Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, Italy.
Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK.
Biomed Res Int. 2021 May 26;2021:3973924. doi: 10.1155/2021/3973924. eCollection 2021.
Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: "aortic valve stenosis," "aortic valve operation," and "transcatheter aortic valve therapy." Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.
主动脉瓣狭窄是一种患病率不断增加的疾病，表现为心输出量减少，如果不治疗，可导致心力衰竭，最终导致死亡。它主要发生在老年人身上，这些人通常有多种合并症。经导管主动脉瓣治疗的出现改变了我们治疗这些疾病的方式。然而，这些治疗方法的长期结果仍然不确定。最近，越来越多的研究探讨了外科主动脉瓣置换和经导管主动脉瓣置换的作用。因此，我们使用 Ovid MEDLINE、Ovid Embase 和 Cochrane 图书馆进行了系统评价。两名研究人员使用以下术语搜索了 2007 年 1 月 1 日至目前发表的论文：“主动脉瓣狭窄”、“主动脉瓣手术”和“经导管主动脉瓣治疗”。主动脉瓣狭窄治疗的两种策略都突出了特定的适应证，以及结构性瓣膜退化和瓣膜血栓形成等对临床结果有影响的陷阱。我们提出了一些建议，以帮助临床医生在决策过程中做出选择，因为技术进步使外科和经导管治疗都成为主动脉瓣狭窄患者的可行选择。最后，我们评估了有限元分析在主动脉瓣置换患者选择中的作用。THVT 和 AVR-S 都是治疗主动脉瓣狭窄的有用工具。两种治疗策略之间的选择最好以强有力的循证医学为指导，理想情况下需要长期随访。这最好由心脏团队在以患者为中心的讨论中进行。
